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The use of neoadjuvant systemic therapy (NST) for the treatment of primary breast cancer has constantly increased, especially in trials of new therapeutic regimens. In the 1980 s, NST was shown to substantially improve breast-conserving surgery rates and was first typically used for patients with inoperable locally advanced or inflammatory breast cancer. Investigators have since also used NST as an in vivo test for chemosensitivity by assessing pathologic complete response. Today, by using pathologic response and other biomarkers as intermediate end points, results from trials of new regimens and therapies that use NST are aimed to precede and anticipate the results from larger adjuvant trials. In 2003, a panel of representatives from various breast cancer clinical research groups was first convened in Biedenkopf to formulate recommendations on the use of NST. The obtained consensus was updated in two subsequent meetings in 2004 and 2006. The most recent conference on recommendations on the use of NST took place in 2010 and forms the basis of this report.

Neoadjuvant immunotherapy (NIT) is a rapidly emerging paradigm for advanced resectable non-small cell lung cancer (NSCLC). However, there is no bibliometric analysis in this research field. To analyze the hotspots and trends in the research of NIT for NSCLC and provide a reference for the study of NIT for lung cancer in China. Retrieve literature related to NIT for NSCLC from Web of Science, PubMed, and Scopus databases up to September 10, 2024. Use CiteSpace and VOSviewer software visualization software to analyze the keywords of country, author, institution, and literature. There were 1575 references, and the overall annual publication volume showed an upward trend; Forde and Patrick M have published the most articles in the literature. The research hotspots mainly focus on chemotherapy, NIT for NSCLC, immunotherapy, neoadjuvant chemotherapy, pathological reactions, etc. This is the first bibliometric study comprehensively summarizing NIT's research trends and development in NSCLC. Our bibliometric assessment provides a panoramic view of the research milieu surrounding NIT for NSCLC, encapsulating the present state, evolving trends, and potential future directions, particularly emphasizing the promise of immunochemotherapy.

Pancreatic ductal adenocarcinoma remains a disease with a poor prognosis despite advances in surgery and systemic therapies. Neoadjuvant therapy strategies are a promising alternative to adjuvant chemotherapy. However, their role remains controversial. This meta-analysis aims to clarify the benefits of neoadjuvant therapy in resectable pancreatic ductal adenocarcinoma. Eligible studies were identified from MEDLINE, Embase, Web of Science and the Cochrane Library. Studies comparing neoadjuvant therapy with a surgery first approach (with or without adjuvant therapy) in resectable pancreatic ductal adenocarcinoma were included. The primary outcome assessed was overall survival. A random-effects meta-analysis was performed, together with pooling of unadjusted Kaplan-Meier curve data. A total of 533 studies were identified that analysed the effect of neoadjuvant therapy in pancreatic ductal adenocarcinoma. Twenty-seven studies were included in the final data synthesis. Meta-analysis suggested beneficial effects of neoadjuvant therapy with prolonged survival compared with a surgery-first approach, (hazard ratio 0.72, 95% confidence interval 0.69-0.76). In addition, R0 resection rates were significantly higher in patients receiving neoadjuvant therapy (relative risk 0.51, 95% confidence interval 0.47-0.55). Individual patient data analysis suggested that overall survival was better for patients receiving neoadjuvant therapy ( = 0.008). Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change.

Neoadjuvant treatment followed by radical surgery has become the standard treatment approach for locally advanced esophageal cancer. We aimed to explore the development trends, research hotspots, and differences among treatment regimens in this field using bibliometric analysis and meta-analysis. Literature on neoadjuvant therapy for esophageal cancer was retrieved from PubMed, Embase, Cochrane Library, and Web of Science. Bibliometric analysis and visualization were conducted on publications since 2000 from Web of Science Core Collection (WoSCC) using CiteSpace, VOSviewer, and the bibliometrix package in RStudio. A meta-analysis of phase III randomized controlled trials (RCTs) involving different treatment regimens was performed using Stata/MP, based on studies screened from all four databases. A total of 1,324 and 27 studies were included in the bibliometric analysis and meta-analysis, respectively. Overall, there was an increasing trend in the volume of publications in this field. The United States and the Karolinska Institute emerged as the leading country and institution in terms of publication volume. The most frequently cited journals and authors were Annals of Surgery and van Hagen P, respectively. Research hotspots have primarily focused on neoadjuvant chemotherapy (NCT) and chemoradiotherapy (NCRT), with a recent shift toward neoadjuvant immunotherapy (NIT). The pooled complete pathological response (pCR) rates were 0.08 for NCT, 0.29 for NCRT, 0.22 for neoadjuvant chemoimmunotherapy (NCIT), and 0.27 for NCRT combined with targeted therapy (NCRT+NTT). The pooled rates of tumor regression grade 1 (TRG1) were 0.09, 0.25, 0.30, and 0.37, respectively. The R0 resection rates were 0.87, 0.96, 0.99, and 0.96, while the incidence of grade ≥3 treatment-related adverse events (TRAEs) was 0.37, 0.66, 0.25, and 0.69, respectively. Neoadjuvant therapy for esophageal cancer has evolved significantly over the past decades. Recently, NIT has emerged as a key area of research interest. However, its clinical efficacy and safety require validation through long-term follow-up data from future phase III RCTs.

There is now accumulating evidence that the host immune system plays an important role in influencing response to treatment and prognosis in breast cancer. Immunotherapy with immune checkpoint inhibitors is a promising and rapidly growing field of interest in many solid tumours, including breast cancer. Trials to date have largely focused on metastatic triple-negative disease, a genomically unstable subtype of breast cancer that is believed to be the most immunogenic and following the development of treatment resistance, has limited treatment options and a particularly poor prognosis. Both checkpoint inhibitor monotherapy and combinations with chemotherapy are being investigated. In this review, we discuss the current evidence for PD-1/PD-L1 blockade in metastatic triple-negative breast cancer (TNBC), HER2+ breast cancer and ER+ disease, as well as the emerging evidence for use in the early-stage (neoadjuvant) setting. We also propose potential ways of improving responses to checkpoint blockade in breast cancer.

The 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery). Section leads were identified based on research interests, with invited input from experts in specific areas, supported by consultation with members of the Association of Breast Surgery and Independent Cancer Patients' Voice groups. The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Key research gaps included issues surrounding overdiagnosis and treatment; optimising treatment options and their selection for neoadjuvant therapies and subsequent surgery; reducing rates of re-operations for breast-conserving surgery; generating evidence for clinical effectiveness and cost-effectiveness of breast reconstruction, and mechanisms for assessing novel interventions; establishing optimal axillary management, especially post-neoadjuvant treatment; and defining and standardising indications for risk-reducing surgery. We propose strategies for resolving these knowledge gaps. Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and health-care systems. Development of infrastructure and surgical research capacity, together with appropriate allocation of research funding, is needed to successfully address the key clinical and translational research gaps that are highlighted in this Review within the next two decades.

Surgical excision is the treatment of choice for early stage melanoma, and this strategy is initially curative for the vast majority of patients. However, only approximately 40–60% of high-risk patients who undergo surgery alone will be disease-free at 5 years. These patients will ultimately experience loco-regional relapse or relapse at distant sites. The main aim of adjuvant therapies is to reduce the recurrence rate of radically operated patients at high risk and to potentially improve survival. Recent practice changing results with immune checkpoint inhibitors and targeted therapies have been published in stage III/IV melanoma patients, after surgical complete resection, and have dramatically improved the landscape of adjuvant therapy. Interferon-α, ipilimumab, and more recently anti-programmed cell death protein-1 antibodies and BRAF inhibitors plus MEK inhibitors have been approved in the adjuvant setting by the US Food and Drug Administration; similarly, the same drugs are approved by the European Medicines Agency with the exception of ipilimumab. A completely new scenario is emerging in the neoadjuvant setting as well: in locally advanced or metastatic disease, patients may partially respond to neoadjuvant therapy and become virtually resectable with systemic control of disease. This review summarizes the current state of the field and describes new strategies tracing the history of adjuvant therapy in melanoma, with a view on future projects.

Background Little is known about how use of chemotherapy has evolved in breast cancer patients. We therefore describe chemotherapy patterns for women with stage I-IIIA breast cancer in the Optimal Breast Cancer Chemotherapy Dosing (OBCD) Study using data from KPNC (Kaiser Permanente Northern California) and KPWA (Kaiser Permanente Washington). Findings Among 33,670 women, aged 18 + y, diagnosed with primary stage I-IIIA breast cancer at KPNC and KPWA from 2006 to 2019, we explored patterns of intravenous chemotherapy use, defined here as receipt of intravenous cytotoxic drugs and/or anti-HER2 therapies. We evaluated trends in chemotherapy receipt, duration over which chemotherapy was received, and number of associated infusion visits. In secondary analyses, we stratified by receipt of anti-HER2 therapies (trastuzumab and/or pertuzumab), given their longer duration. 38.9% received chemotherapy intravenously, declining from 40.2% in 2006 to 35.6% in 2019 (p-trend < 0.001). Among 13,089 women receiving chemotherapy, neoadjuvant treatment increased (4.1–14.7%; p-trend < 0.001), as did receipt of anti-HER2 therapies (20.8–30.9%) (p-trend < 0.001). The average treatment duration increased (5.3 to 6.0 months; p-trend < 0.001), as did the number of infusion visits (10.8 to 12.5; p-trend < 0.001). For those receiving anti-HER2 therapies, treatment duration and average number of visits decreased; among those not receiving anti-HER2 therapies, number of visits increased, with no change in duration. Conclusions While the prevalence of chemotherapy receipt has decreased over time, the use of neoadjuvant chemotherapy has increased, as has use of anti-HER2 therapies; duration and number of administration visits have also increased. Understanding these trends is useful to inform clinical and administrative planning.

Advances in research have transformed our understanding of breast cancers and have altered the daily practice of pathology. Theranostic evaluations performed by pathologists are now critical in triaging the patients into appropriate treatment groups, as are new guidelines that were recently established for the evaluation of HER2/neu gene amplification. Emerging molecular classifications of breast cancers bring novel perspectives to the assessment of individual cases, and opportunities for better treatments. Molecular studies have particularly shed light on distinct biological subsets of triple-negative breast cancers, for which new targeted therapies are being developed. The prognostic and therapeutic utility of new histopathologic parameters, such as tumor-infiltrating lymphocytes, are also being elucidated, and new protocols have been devised for the pathologic evaluation of breast specimens that have undergone neoadjuvant treatment. Novel clinical practices, such as radioactive seed localization, also affect the way breast specimens are processed and evaluated. In this brief review, we highlight the developments that are most relevant to pathology and are changing or could potentially impact our daily practice.

Background Neoadjuvant chemotherapy (NAC) downstages tumor size and nodal disease. This study evaluates national practice patterns of NAC use in hormone receptor-negative breast cancer. Methods We identified patients in the National Cancer Data Base (NCDB) with hormone receptor-negative invasive breast cancer (2004–2012). Univariate and multivariable logistic regression was used to assess associations and trends across time. Results Of 171,985 patients, 130,723 (76.0%) received chemotherapy and 41,262 (24.0%) did not. Chemotherapy use was higher in young patients and higher T- and N-stage disease (all p   <  0.001). Of those patients treated with chemotherapy, 23,165 (17.7%) received NAC and 107,558 (82.3%) received adjuvant chemotherapy (AC). NAC use increased from 2004 to 2012 (13.0–23.5%; adjusted odds ratio [aOR] 1.42; p   <  0.001). Higher clinical T stage (ORs 3.63, 11.81, and 22.34 for cT2, cT3, and cT4a–c, respectively, vs. cT1) and cN+ disease (OR 2.86) [each p   <  0.001] were associated with NAC, as were younger patient age and better Charlson–Deyo comorbidity score. Furthermore, BCS rate was higher in the NAC group in cT2 and cT3 tumors (aOR 1.17 and 1.45, respectively; both p   <  0.001). In patients with cN+ disease, NAC converted 43.7% to pN0. Less extensive axillary surgery (one to five nodes removed) was more likely in cN+ patients treated with NAC (aOR 1.66; p   <  0.001). Conclusions In hormone receptor-negative breast cancer, chemotherapy was mostly administered adjuvantly, but neoadjuvant use increased over time and was more likely in younger patients and higher T- and N-stage disease. Node-positive patients treated with NAC were less likely to have pathologically positive nodes and more likely to have less extensive axillary surgery.